Individual provider Active NPI

Susi Madrigal-Leon, FNP-C

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1346902459
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.022696 Issued in IL
Practice address
736 SW Washington St
Suite 2a
Peoria, IL 61613-1643
Phone
(309) 497-0300
NPI assigned
Oct 6, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.022696 IL Primary

Addresses

Primary practice location

736 SW Washington St
Suite 2a
Peoria, IL 61613-1643

Mailing address

736 SW Washington St Ste 2a
Peoria, IL 61602-1643
Phone (309) 497-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220713000577 IL Practitioner - Nurse Practitioner 8426439159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

5105 N Glen Park Place Rd
Peoria, IL 61614-4688
Phone (309) 308-5900

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.022696ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 1, 2022 Accepting new patients
Iwin (Integrated Work Injury Network) PastSince Oct 10, 2021 Accepting new patients
Ciwirc ( Central Illinois Work Injury Resource Center ) PastSince Oct 10, 2021 Accepting new patients

Locations

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

5105 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 308-5900

330 SW Adams St
Peoria, IL 61602
Phone (309) 402-2978

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1346902459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 SW WASHINGTON ST STE 2A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021643",
            "telephone_number": "309-497-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 SW WASHINGTON ST",
            "address_2": "SUITE 2A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616131643",
            "telephone_number": "309-497-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADRIGAL-LEON",
        "first_name": "SUSI",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.